Category: Insulin Resistance

by Marcelle Pick, OB/GYN NP

We have all heard about diabetes and how prevalent it is becoming in our country, especially Type 2. This condition, although commonly called “adult-onset diabetes”, actually affects people of all ages, and is connected to a diet high in sugar, lack of exercise, and even some environmental factors. But just recently, researchers have revealed another type of diabetes similar to Type 2 that is linked to Alzheimer’s disease. Scientists are now saying Alzheimer’s and dementia may actually be a form of diabetes, known as Type 3 diabetes. This is a huge discovery!

Nearly every day in my practice I come across patients who are on their way to developing insulin resistance, a pre-cursor to diabetes. Because the symptoms may be minimal at first, many people do not even know they have it. We are proactive when it comes to checking blood sugar levels, and we always encourage our patients to eat nutritiously, exercise, and curb chronic stress. But now we have evidence that these factors are more important than ever in preventing a number of diseases, including the recently identified Type 3 diabetes. The good news is, we can virtually stop this disease before it even starts. Let’s take a look at the bigger picture.

What is Type 3 diabetes?

Diabetes occurs when the pancreas is unable to make adequate amounts of insulin, a hormone released to help cells absorb glucose (also known as blood sugar), providing us with energy. Diabetes is divided into categories, and each characterized by its own set of circumstances.

Type 1 diabetes usually develops in children or young adults and cannot be corrected with diet or a change in lifestyle. Type 1 is genetically predetermined, and requires daily insulin injections to balance glucose levels.

Type 2 diabetes happens when the cells cannot identify or absorb the insulin put out by the pancreas, and usually occurs with obesity, and/or a strong family history of diabetes. The good news is that in its earlier stages, Type 2 is easier to manage with diet and lifestyle modifications.

With Type 3 diabetes, the researchers at Brown Medical School and Rhode Island Hospital discovered that insulin is not only released from the pancreas, but also the brain. This opens a whole new perspective on both diabetes and Alzheimer’s – the progressive degenerative disorder causing loss of memory, intellectual capacity and even personality changes.

Type 3 diabetes is an extension of Type 1 and Type 2, and follows a similar pathophysiology as Type 2, but in the brain. Insulin is needed to help the neurons in the brain absorb glucose for healthy functioning, and if the cells in the brain become insulin-resistant, it can lead to Alzheimer’s.

This form of dementia worsens over time, eventually impeding daily functioning. Early diagnosis is critical to try to slow down the disease and help maintain quality of life. For many years, an Alzheimer’s diagnosis has been linked to genetics and lifestyle, diet, diabetes, high blood pressure, and high cholesterol. The groundbreaking study at Brown not only shows us this common thread, but teaches us that we can actually change the way our brain cells respond by controlling our diets. This is amazing news!

Ways to help prevent Type 3 diabetes

Since the link between diet and diabetes – and now Alzheimer’s – has been established, let’s think about our lifestyle. We live in a country of “super-sized”, easily accessible, processed foods, providing quick energy. High on refined sugar, but low on nutrition, these foods, including processed meats, fast food, donuts, sugary colas, and candy, can actually inhibit cell functioning, leading down a pathway to disease.

Some healthier choices include fresh fruits, green, leafy vegetables, whole grains, high-fiber breads and cereals, fish, nuts, and legumes. A healthy diet lowers our risk of diseases, boosts our immune system, and even helps delay the aging process, not to mention we feel better when we eat right.

In addition to good nutrition, exercise also plays an important role in keeping our cells, and therefore our body, functioning properly. The key here is to do something you enjoy, so you do it consistently. The benefits of exercise are numerous. Not only does it improve our resistance to disease, it helps reduce inflammation associated with disease, sharpen our minds, and keeps all of the systems in our body flowing smoothly.

Reducing our exposure to environmental toxins is also helpful in preventing Type 3 diabetes. We know that cigarette smoke, air and industrial pollutants, and artificial chemicals can pose hazards to our health. Although the studies are fairly new, researchers are also investigating electropollution, or frequent exposure to the energy emitted from electronic devices, as a contributor to this form of diabetes. Since we are almost constantly exposed to technology, how do we combat electropollution? Fresh air. A brisk walk outside has been shown to reduce blood sugar.

At Women to Women, we work with our patients each and every day on the importance of lifestyle balance. We know that obesity, lack of exercise, chronic stress, and not enough sleep can cause a number of health issues, such as heart disease, diabetes, metabolic syndromes, risk of stroke, and impaired brain function. We can now add Alzheimer’s to our list of nutrition-modulated, potentially preventable diseases.

I’m excited to learn about this study, as its results may change the course of a disease that impacts not just those who have it, but families, caregivers, and medical providers. When we can control so many of the factors that lead to diseases like Type 3 diabetes, we can become empowered. Imagine being able to not only improve your health span, but do it with a sharp mind and renewed energy.

by Marcelle Pick, OB/GYN NP

Insulin resistance is so pervasive today that we evaluate nearly every woman who visits our clinic to determine her level of risk. Most are taken aback when they learn they either already have the condition or are well on their way to developing it. Experts estimate that 25% of all Americans suffer from insulin resistance. We believe the percentage is much higher among perimenopausal women.

The health effects of insulin resistance — also called Syndrome X — are dramatic. Besides leading directly to diabetes, it’s been implicated in heart disease, breast cancer, Alzheimer’s, polycystic ovarian syndrome (PCOS) and many more diseases. It also often accompanies, and contributes to, related problems of hormonal imbalance such as adrenal fatigue.

Because insulin is one of the “major” hormones, it’s also impossible for your body to balance its “minor” hormones (estrogen, progesterone and testosterone among them) until your insulin metabolism is balanced first. To put it simply, if you have hot flashes and you are insulin resistant, it’s going to be nearly impossible to cure the hot flashes without first healing the insulin resistance.

The good news is that you can heal insulin resistance. This has been a primary focus of our practice at Women to Women for over a decade, and our approach has been quite successful. Let’s explore our methods and how they might help you.

Why all the concern about insulin resistance?

Over 80 million Americans suffer from insulin resistance, and it appears to sit at the center of a web of related health problems. Women who are insulin resistant are at much greater risk of obesity, diabetes, hypertension (high blood pressure), heart disease, high cholesterol, breast cancer and polycystic ovarian syndrome (PCOS). There is some evidence that insulin resistance may contribute to endometrial cancer. It’s also been implicated in Alzheimer’s disease.

Insulin resistance often accompanies the most common complaints we hear at Women to Women — fatigue and weight gain. As women approach menopause, they become increasingly intolerant of carbohydrates and find it easier to gain weight, especially around their waists. Afternoon blahs, sugar crashes and carbohydrate cravings may all be early symptoms of insulin sensitivity.

Insulin sensitivity – the way it should work

All of the food we eat – fats, proteins and carbohydrates — is broken down during digestion into proteins, micronutrients and glucose. The body uses the proteins and nutrients in cellular metabolism, immune function, and cell replacement. The body uses glucose as its basic fuel, which is carried by the bloodstream to individual cells.

Our demand for fuel varies from moment to moment, but the brain needs our blood sugar level to remain stable. So getting the cells the energy they need without changing that level is a critical function — and that’s the role that insulin plays. Insulin signals the cells to absorb glucose from the bloodstream. The body monitors what we’ve digested, blood sugar levels, and cell demands, and releases insulin in just the right amounts. That’s why a healthy body is described as “insulin sensitive”.

How insulin resistance develops

Our metabolism evolved eons ago, when our diet included fewer and more complex carbohydrates. Today most calories in an average diet come in the form of carbohydrates, and most of those are simple carbohydrates — sugars that quickly enter the bloodstream. The body has to release high levels of insulin to keep the level of glucose in the bloodstream from spiraling out of control. But in time the cells quit responding to this signal. At this point the body is “insulin resistant”.

One immediate consequence is that the body is forced to release even more insulin. Letting blood sugar get too high is simply not acceptable. But the body wasn’t designed for these prolonged high levels of insulin, which disrupt cellular metabolism and spread inflammation. Diabetes occurs when the body fails to keep blood glucose under control. But as we have noted, that is only the most obvious of the diseases caused by insulin resistance. There are many negative health effects before full-blown diabetes.

Insulin resistance and menopause

Of special concern to women is how insulin resistance disrupts fat metabolism. When the cells won’t absorb the extra glucose, the liver has to convert it into fat. Fat cells are loaded with glucose receptors, so this is a vicious cycle. Ironically, while the insulin-resistant woman is gaining weight, her cells are actually “starved” for glucose, so she feels exhausted and tends to eat carbohydrate-heavy foods in search of energy.

These extra fat cells are also little estrogen factories. That contributes to the estrogen dominance that causes so many symptoms during the early stages of perimenopause.

Symptoms relating to insulin resistance usually predate the onset of menopause, but most women do not complain of them until then. Women’s health can deteriorate rapidly during menopause with the decrease of estrogen stores in the body. Digestive issues that were once a hassle become an affliction when the body’s natural defenses against inflammation (estrogen being one) are depleted.

In addition, women approaching menopause are particularly prone to insulin resistance due to metabolic changes related to fluctuations in adrenal and thyroid secretions. In fact, the decrease of certain hormones, like estradiol, may trigger a sensitivity to insulin in patients that had never experienced it before. Certain blood pressure medications can mask symptoms without treating the problem. Frequently, women unwittingly exacerbate their condition by fighting weight gain with low-fat, high-carbohydrate diets.

How do I know if I’m insulin resistant?

The unfortunate truth is that anyone can become insulin resistant even if they are thin. We are all at risk in our in our society where we have access to a lot of refined carbohydrates (white bread, sugar, bagels, pasta, potatoes, Coke/Pepsi, processed foods with added fructose, etc.). In fact, most of us are likely to be somewhat sensitive to insulin. It is just a matter of degree. The more processed and refined food that we eat, the more insulin we require to metabolize it. The more insulin in our blood, the less responsive our cells become. As we age, this continual exposure wears out our tolerance for refined carbohydrates and reduces our sensitivity to insulin.

If you suffer from high cholesterol, high triglycerides, and hypertension, you should get checked for insulin resistance, regardless of your weight or age. If you have high blood pressure, it is likely that you are also suffering from insulin resistance. High blood pressure medication will not cure insulin resistance.

The greatest risk factors for Syndrome X

You are at the highest risk for developing this condition if you have a family history of Type 2 Diabetes or if you have suffered from gestational diabetes, hypertension, or are seriously overweight.

Apple-shaped women, or those who tend to gain most of their weight around their abdomen, show less tolerance for insulin. To assess your risk, measure yourself around the smallest part of your waist (don’t hold your stomach in!) and the biggest part of your hips. Divide the waist measurement by the hip measurement. A ratio bigger than 0.8 for women (or 1.0 for men) indicates that your abdomen is obese and you are at risk for developing insulin resistance.

Women with dyslipidemia, especially those with low HDL levels and high triglycerides, may also be resistant. I tend to look at the ratio of HDL to triglycerides. If I can divide the triglyceride count by the HDL count and get a three or more, I immediately suspect insulin resistance. A skin change called acanthosis nigricans, which is warty-like darkened patches of skin at the neck and armpits, indicates insulin resistance in over 90% of the women who experience it. The good news is that insulin and glucose levels are very easily influenced by changes in lifestyle, exercise, and diet. If you are diagnosed with insulin resistance, there is a lot you can do to reverse its course.

Bringing insulin into check

At Women to Women, we understand that insulin resistance may be an underlying factor in a range of health problems. Before designing a patient’s plan, we always take into consideration this possibility. Our goal at Women to Women is to enable all our patients to feel energetic, lively, attractive, passionate, and excited for years to come, as opposed to feeling lethargic, irritable, and hormonally imbalanced. Thankfully, we have discovered that a lot that can be done to decrease a patient’s insulin sensitivity and bring their hormones back into natural balance.

When we evaluate a patient for insulin resistance, we recommend a blood test for glucose and insulin levels after fasting for 12 hours and then again two hours after a meal (preferably a high-carbohydrate meal). On the fasting tests, we hope to see glucose levels of no more than 75-80 and insulin of less than 14; higher levels indicate a risk of insulin resistance. Increased triglycerides make me suspicious too. We also take into account the patient’s lifestyle, diet and exercise patterns, and stress factors. All of this can be changed with diet and lifestyle modifications.

Talk to your primary care provider about being tested if you feel you are at risk. Many younger practitioners are familiar with the concept of insulin resistance, as it is now being taught in medical school. Unfortunately old-school physicians may still be unaware of its importance.

Healthy habits

If a patient presents with insulin sensitivity, I recommend a reevaluation in their diet and exercise habits. I encourage all of my patients to shop the outside aisles of the supermarket, and to studiously avoid the inner rows of processed food, sugar cereals, high-sodium snacks and soda.

A diet that consists primarily of lean meats and dairy; high-fiber grains, vegetables and legumes; leafy greens; and fruit will substantially aid the body’s ability to balance insulin levels. If a patient is already insulin resistant, I recommend a meal plan consisting of breakfast, lunch, dinner, and two snacks. Each meal should have 15 grams of carbohydrates in the form of vegetables and fruits (and prohibiting “white” food such as bread, pasta, and sugar) and some lean protein. Each snack should contain only 7 grams of similar carbohydrates. Healthy fats, or those rich in essential fatty acids (EFAs), are also important. EFAs can be found in avocados, cold-water fish like salmon and tuna, flax seed, and eggs.

I also recommend a pharmaceutical-grade nutrient plan which can help decrease carbohydrate and sugar cravings, but also helps normalize the hormonal function in menopausal and perimenopausal patients.

Regular exercise of 30 minutes or more per day, 3-5 times a week is also beneficial for regulating metabolic function and hormonal balance. Decreasing stress, thereby lessening strain on the adrenal glands will result in better overall health and contribute to keeping the body’s insulin levels in check. Stopping smoking, moderating alcohol intake and proper sleeping habits will help to alleviate chemical blood surges, which in turn will promote a thriving, well-balanced body.

Hopefully the picture that’s emerging is that your body’s hormonal balance is like a symphony. Insulin is one of the loudest and most important instruments. When its metabolism goes wrong, it throws off everything else. We’ve seen over and over that women with menopause symptoms must reverse their insulin resistance in order to find relief. The good news is that it can be done, and our job is to help you understand what needs to be done and then you can do just that.

by Marcelle Pick, OB/GYN NP

Have you ever been with a group of friends or co-workers and had someone say they just have to have something sweet?  Does a family member talk about her sweet tooth?  Do you?

Some women are fully aware of their cravings for sugar and their sugar intake – and some are really surprised when they start talking about it – or even tracking it. For many years I listened to women who talked about how strong these their cravings were and how difficult it was to remove sugar from the diet. It became so evident that sugar cravings were not about willpower. I came to understand that there are real physiologic reasons. Sugar affects our brains in many of the same ways as drugs and alcohol – it’s an addictive substance! As a Functional Medicine Practitioner, I know that sugar can contribute not only to weight gain, diabetes, dental issues, but hormone imbalance, osteoporosis and some forms of cancer.

If you find that you’re craving sugar on a regular basis, there may be physical causes! For many women hormonal fluctuations can disrupt insulin, which is one of our major hormones. Estrogen and progesterone imbalances may soon follow. Hormones which are out of balance may cause anxiety, irritability, fatigue and much more!

Internal yeast may be another culprit and stress, which causes our body to produce increased levels of cortisol, may also be a contributor.

We also have to remember that carbohydrates and extra sugar that aren’t used by your body are stored in the liver as glycogen. When there’s more glycogen than is needed, your body will make fat from the extra sugar. This fat is stored and you’ll see the results in the mirror and on the scale.

Understanding why cravings exist is only part of the puzzle – how do you keep your sugar cravings in check?

One of the easiest first steps I recommend to my patients is to have protein with every meal or snack. A piece of lean protein, cheese or nuts will help balance a carbohydrate filled (or sugary!) snack. The protein will help balance your blood sugar and avoid a sharp peak and crash after. Apples with cashew butter, cheese with crackers or even a slice of lean turkey with crackers are all great ideas.

You may want to investigate food sensitivities. So many of my patients find that when they remove foods they are sensitive to from their diets, their sugar cravings all but disappear. Food sensitivity testing is one option, but you can also remove the most common allergens from your diet or keep a food journal, tracking your reactions to certain foods. The most common allergens are gluten and dairy. Other foods to consider are citrus, eggs, peanuts, soy and corn.

For some women, removing sugar from their diets is worth the first difficult days. If you aren’t sure if sugar is a culprit for you in some of your underlying symptoms, then you may want to consider a break from sugar for five to seven days. If you find you can’t stop ‘cold turkey’, then gently cut back over a period of three to five days. Some patients tell me that they will see a relief in symptoms in those first few days! Many women report feeling more clear and energized after being off sugar for just a short period of time.

You may want to consider adding a dietary supplement and omega-3 to your diet. Omega-3s can help with calming inflammation and mood regulation. B Vitamins, vitamin C, chromium and other micronutrients can be helpful in calming sugar cravings as well.

Keeping your diet balanced can also calm cravings. Choosing foods high in omega-3 fatty acids, eating foods that are alkalizing (like vegetables and fruit and limiting red meat) and refined carbohydrates which increase inflammation can help keep cravings at bay.

An overgrowth of yeast can lead digestive issues, fatigue, fuzzy thinking and intense sugar cravings. Yeast thrives on sugar – your body will crave the very culprit exacerbating your symptoms! Eliminating sugar from your diet is the first step toward regaining balance.

Stress – a body under stress craves fuel. When you are stressed and tired, it’s difficult to maintain healthy eating habits – often times we’ll reach for the quick fix – and many times carbohydrates and sugar can be the choice. It’s important to remember that stress will increase cortisol production which affects our hunger hormones. Maintaining healthy stress levels is so important! Be sure to carve some time out of your day for stress relief – even a few minutes a day can make a difference!

Remember to keep emotional sweetness in your life! Saying goodbye to sugar may be hard – but the physical effects are definitely worth it. Be sure to keep sweetness in your life every day. Be sure to find something you enjoy every day – a phone call with a friend, a walk outside, meditation to relax or reading a few pages from a good book!

by Marcelle Pick, OB/GYN NP

You feel tired, hungry, and are gaining weight. The afternoon “blahs” are part of your daily life. Maybe you feel thirstier, or wake up at night and need to go to the bathroom. These symptoms are some of the most common we hear at Women to Women, and may be a sign of insulin resistance – a precursor to diabetes, and other major health problems.

Over 80 million Americans suffer from insulin resistance, also known as “syndrome X.”  Many people do not even know they have it, so are likely unaware of the health problems associated with the syndrome. Women with insulin resistance have a greater risk of many disorders, including diabetes, hypertension, heart disease, obesity, high cholesterol, breast cancer, and polycystic ovarian syndrome (PCOS) among other things. Because syndrome X poses such risks and is so pervasive, we evaluate nearly every woman who visits our clinic, and many are quite surprised when they learn their symptoms are actually caused by insulin resistance.

The good news is that we can not only treat insulin resistance, but we can heal it. Let’s take a look at what it is and what causes it.

So what is insulin resistance?

Insulin is a hormone produced in the pancreas. It helps control glucose, or blood sugar. Glucose is our body’s key source of energy, fueling our bodies to function. All of the food we eat is broken down into proteins and nutrients, which are used in metabolism, cell replacement, and immune function. The amount of fuel we need varies all the time, but our blood sugar levels need to remain stabilized. Insulin helps regulate those levels.

Normally glucose is carried by the bloodstream to individual cells, and insulin signals the cells to absorb the glucose that fuels our body. But when there is too much glucose in the body, cells become desensitized and the body continues to release more insulin, allowing blood sugar levels to become high. Prolonged high levels of insulin disrupts cellular metabolism, increases inflammation, and eventually the cells quit responding to the signal from insulin — creating insulin resistance. Diabetes is just one of the common diseases resulting from insulin resistance, and occurs when the body is unable to manage blood glucose levels.

The body works hard to balance what is digested, monitor blood sugar levels, meet cell demands, and release insulin in just the right amounts. Metabolism plays a key role in glucose functioning–it defines how the body regulates energy. Our diets affect our metabolism, and a diet consisting mostly of simple carbohydrates found in refined and processed foods, results in the fast break down of sugars that quickly enter the bloodstream. As this occurs, the body releases more insulin to try to control the glucose levels, creating a downward spiral. However, a diet rich in complex carbohydrates, such as whole grains, fruits, and vegetables, aids metabolism and its relationship to insulin, tipping the scales in the right direction.

Signs of insulin resistance

It is estimated that over 30 percent of Americans have insulin resistance or syndrome X. A combination of factors can contribute to this condition:

• Family history of Type 2 diabetes
• Hypertension (high blood pressure – certain high blood pressure medications may mask symptoms)
• Obesity
• High cholesterol
• Gestational diabetes
• Heart disease
• Dyslipidemia (an abnormal ratio of fats and cholesterol in the blood)
• Acanthosis nigricans (darkened patches of skin at the neck, and sometimes the elbows, knees, armpits, and knuckles)
• An apple-shaped body (carrying more weight around the mid-section)

Even without these factors, almost anyone can be insulin resistant because of diet. Refined carbohydrates, found in processed foods, white breads, bagels, pasta, sodas, sugary sweets, and many other foods on America’s grocery lists, contribute to syndrome X. When we eat processed foods, our body requires more insulin to metabolize it, and our cells become less responsive. As we get older, our sensitivity to insulin changes, regardless of our weight. It never hurts to be checked for this condition. Another factor that may contribute to syndrome X is menopause.

Menopause and insulin resistance

For women in menopause, there may be an increase of syndrome X symptoms due to metabolic changes, including fluctuations in adrenal and thyroid secretions. And, since insulin is a predominant hormone, the body may have trouble balancing the subsidiary hormones like estrogen, progesterone, and testosterone. The decrease of other hormones like estradiol can even trigger insulin resistance in some women.

Balancing insulin is key to managing many of the symptoms associated with menopause and even perimenopause (the years leading up to menopause when hormones can frequently vacillate, causing a host of symptoms).  Some may even be easily confused with syndrome X, such as fatigue, urinary urgency, difficulty sleeping and mood swings.

A plaguing issue for women in menopause is weight gain. Insulin resistance disrupts metabolism, causing extra glucose to be converted into fat. Since fat cells are loaded with glucose receptors but cannot absorb glucose, this vicious cycle creates fatigue, and a desire for energy which often leads women to reach for foods loaded with carbohydrates.

Not only are fat cells hungry for energy, they also make excess estrogen, which contributes to estrogen dominance, contributing to many symptoms during the perimenopause years leading. When estrogen is finally depleted with the onset of menopause, digestive issues may become more prominent due to inflammation which was once controlled by estrogen. If not tended to, a woman’s health can quickly deteriorate during menopause, and insulin resistance is just one of the hidden culprits.

How to control insulin resistance

As I mentioned earlier, syndrome X is not a life sentence, and so can easily be dealt with because glucose levels can be influenced by lifestyle, proper nutrition, and exercise. This is a primary focus of our practice at Women to Women, and our approach has proven to be so successful. First, we establish whether insulin resistance is indeed an underlying factor by recommending a blood test for glucose and insulin levels. once after fasting for 12 hours, and then again two hours after a meal. If a patient’s blood levels indicate a risk for syndrome X, we recommend ways to help reverse the process, and help bring her hormones back into natural balance. And many of these recommendations are actually easy to do.

• To help balance insulin, consider a diet consisting primarily of lean meats and protein, high-fiber, whole grains, leafy greens, fresh vegetables and legumes, and fresh fruit. Be sure to shop in the outer aisles of the supermarket, avoiding rows of processed, high-sodium, sugary foods, snacks and soda.

• Plan daily meals to consist of breakfast, lunch, dinner, and two snacks. Each meal should contain some lean protein, and no more than 15 grams of carbohydrates, in the form of fruits and vegetables, minimize your grains.

• Each snack should contain only 7 grams of healthy carbohydrates. Be sure to get enough fiber, preferably in the form of vegetables and fruits.

• Essential fatty acids (EFA) or healthy fats, are important to help insulin resistance. These fats include tuna, salmon, and other cold-water fish; fish oil supplements, eggs, avocado, and flaxseed, which can be taken in as a nutritional supplement.

• Taking a pharmaceutical-grade, nutritional supplement can also decrease carbohydrate and sugar cravings. It can also help normalize hormonal function in perimenopausal and menopausal women-a bonus!

• Exercise is an important component to help insulin levels stay normal, maintain hormonal balance, and regulate metabolic function. It also helps decrease stress and lessens the strain on often overworked adrenal glands, which contributes to better health overall.

• Drink alcohol in moderation, get plenty of sleep, and stop smoking. These all help promote a healthier, balanced body.

We at Women to Women want to help all women feel good, healthy, vibrant, and energetic. When insulin levels are off, the entire body works harder, and is out of sync. Reversing insulin resistance will not only help smooth out functioning, it will offer relief for many other symptoms. And sometimes just knowing we can heal it, helps.

by Marcelle Pick, OB/GYN NP

Everyone has a distinctive family history and background. Depending on our genetics, some of us may be able to get away with practicing poor lifestyle habits such as high-sugar diets and little exercise, while others will begin to experience the harsher effects of this type of negative life style, such as developing type 2 diabetes. The good news is you can always start to introduce healthier habits and then the likelihood of developing diabetes can dramatically decrease. If you start to introduce a mixture of positive and healthy eating habits and increasing your activity level positive health changes will begin to be seen both on the outside and on the inside of your body.

It’s always smart to consider and know your risk for developing type 2 diabetes. Early detection is key, especially since its diagnosis levels are on the rise. At Women to Women, we believe that if you have insulin resistance then you already probably have metabolic syndrome and are heading towards type 2 diabetes. It is a good idea to assess where you are today so that you can prevent yourself from joining the growing numbers of individuals that are diagnosed every day. We want you to understand, that whether you are at higher risk of developing diabetes or already have it, that type 2 diabetes can be prevented, treated and even reversed by making healthy changes in your diet and lifestyle.

Here are some of the most common risk factors associated with insulin resistance and type 2 diabetes:

• Being over the age of 45 years
• Being overweight/having meaning having a BMI greater than 24 (note that this cut-off point is lower than for men)
• Having a first-degree relative with diabetes, meaning a sibling or parent.
• Being of African-American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent
• Having had or have gestational diabetes during pregnancy
• Giving birth to a baby weighing greater than nine pounds
• Having blood glucose levels greater than 99 mg/dL, this is an early marker
• Having blood pressure readings commonly 140/90 or higher, this too is an early marker
• Having lipid profiles that show high LDL “bad” or unbalanced cholesterol (your HDL is less than 35 mg/dL or your triglyceride level is over 250 mg/dL) Triglyceride levels are an easy first marker to watch as the correlation is so high between and an elevation and insulin resistance/metabolic syndrome
• Leading an inactive lifestyle
• Having darkening skin around the neck or armpits (acanthosis nigricans)
• Having blood vessel problems that affect the heart, brain or legs

A number of these common risk factors for diabetes are interrelated. For example, if you’re overweight you’re more likely to have high blood pressure, unbalanced cholesterol levels and blood vessel problems. Therefore, the more factors you check off on the above list, the greater your overall risk is. It is important to understand that those of us who follow the modern “Western diet” of over-processed foods, refined sugar products, preservatives, and low fiber are automatically at a much higher risk for developing diabetes than those who eat diets high in fresh, whole foods.

I can’t say it enough, you will be a lot better off if you find out your risk of developing type 2 diabetes early. Keep in mind that no matter how bad your risk may appear, remember there is always hope. There are always ways to prevent this disease or lessen its impact. You are in control when it comes to your health. Also, if you pay attention and make some positive, healthy changes in your life, it’s never too late to change your risk profile!

by Marcelle Pick, OB/GYN NP

Who is at risk for type 2 diabetes?

Everyone has a distinctive family history and background. Depending on our genetics, some of us may be able to get away with practicing poor lifestyle habits such as high-sugar diets and little exercise, while others will begin to experience the harsher effects of this type of negative life style, such as developing type 2 diabetes. The good news is that you can always start to introduce healthier habits and then the likelihood of developing diabetes can dramatically decrease. If you start to introduce a mixture of positive and healthy eating habits and increasing your activity level, positive health changes will begin to be seen both on the outside and on the inside of your body.

It’s always smart to consider and know your risk for developing type 2 diabetes. Early detection is key, especially since its diagnosis levels are on the rise. At Women to Women, we believe that if you have insulin resistance then you already probably have metabolic syndrome and are heading towards type 2 diabetes. It is a good idea to assess where you are today so that you can prevent yourself from joining the growing numbers of individuals that are diagnosed every day. We want you to understand that whether you are at higher risk of developing diabetes or already have it, that type 2 diabetes can be prevented, treated and even reversed by making healthy changes in your diet and lifestyle.

Here are some of the most common risk factors associated with insulin resistance and type 2 diabetes:

• Being over the age of 45 years
• Being overweight/having meaning having a BMI greater than 24 (note that this cut-off point is lower than for men)
• Having a first-degree relative with diabetes, meaning a sibling or parent.
• Being of African-American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent
• Having had or have gestational diabetes during pregnancy
• Giving birth to a baby weighing greater than nine pounds
• Having blood glucose levels greater than 99 mg/dL, this is an early marker
• Having blood pressure readings commonly 140/90 or higher, this too is an early marker
• Having lipid profiles that show high LDL “bad” or unbalanced cholesterol (your HDL is less than 35 mg/dL or your triglyceride level is over 250 mg/dL) Triglyceride levels are an easy first marker to watch as the correlation is so high between and an elevation and insulin resistance/metabolic syndrome
• Leading an inactive lifestyle
• Having darkening skin around the neck or armpits (acanthosis nigricans)
• Having blood vessel problems that affect the heart, brain or legs

A number of these common risk factors for diabetes are interrelated. For example, if you’re overweight you’re more likely to have high blood pressure, unbalanced cholesterol levels and blood vessel problems. Therefore, the more factors you check off on the above list, the greater your overall risk is. It is important to understand that those of us who follow the modern “Western diet” of over-processed foods, refined sugar products, preservatives, and low fiber are automatically at a much higher risk for developing diabetes than those who eat diets high in fresh, whole foods.

I can’t say it enough, you will be a lot better off if you find out your risk of developing type 2 diabetes early. Keep in mind that no matter how bad your risk may appear, there is always hope. There are always ways to prevent this disease or lessen its impact. You are in control when it comes to your health. Also, if you pay attention and make some positive, healthy changes in your life, it’s never too late to change your risk profile!

By Marcelle Pick, OB-GYN NP

You are at the highest risk for developing this condition if you have a family history of type 2 diabetes or if you have suffered from gestational diabetes, hypertension, or are seriously overweight. See our articles on diabetes risk factors for more specifics.

Apple-shaped women, or those who tend to gain most of their weight around their abdomen, show less tolerance for insulin. To assess your risk, measure yourself around the smallest part of your waist (don’t hold your stomach in!) and the biggest part of your hips. Divide the waist measurement by the hip measurement. A ratio bigger than 0.8 for women (or 1.0 for men) indicates that your abdomen is obese and you are at risk for developing insulin resistance.

Women with dyslipidemia, especially those with low HDL levels and high triglycerides, may also be resistant. I tend to look at the ratio of HDL to triglycerides. If I can divide the triglyceride count by the HDL count and get 3.0 or higher, I immediately suspect insulin resistance. A skin change called acanthosis nigricans, which is warty-like darkened patches of skin at the neck and armpits, indicates insulin resistance in over 90% of the women who experience it.

The good news is that insulin and glucose levels are very easily influenced by changes in lifestyle, exercise, and diet. If you are diagnosed with insulin resistance, there is a lot you can do to reverse its course.

Bringing insulin into check

At Women to Women, we understand that insulin resistance may be an underlying factor in a range of health problems. Before designing a plan for a patient, we always take into consideration this possibility. Our goal at Women to Women is to enable all our patients to feel energetic, lively, attractive, passionate, and excited for years to come – as opposed to feeling lethargic, irritable, and hormonally imbalanced. Thankfully, we have discovered that a lot can be done to decrease a patient’s insulin sensitivity and bring their hormones back into natural balance.

When we evaluate a patient for insulin resistance, we recommend a blood test for glucose and insulin levels after fasting for 12 hours and then again two hours after a meal (preferably a high-carbohydrate meal). On the fasting tests, we hope to see glucose levels of no more than 75–80 and insulin of less than 14; higher levels indicate a risk of insulin resistance. Increased triglycerides make me suspicious too. We also take into account the patient’s lifestyle, diet and exercise patterns, as well as stress factors. All of this can be changed.

Talk to your primary care provider about being tested if you feel you are at risk. Many younger practitioners are familiar with the concept of insulin resistance, as it is now being taught in medical school. Unfortunately, old-school physicians may still be unaware of its importance.

By Marcelle Pick, OB/GYN NP

Our metabolism evolved eons ago, when our diet included fewer (and more complex) carbohydrates. Today most calories in an average diet come in the form of carbohydrates, and most of those are simple carbohydrates — sugars that quickly enter the bloodstream. The body has to release high levels of insulin to keep the level of glucose in the bloodstream from spiraling out of control. But in time the cells quit responding to this signal. At this point the body is “insulin resistant.”

One immediate consequence is that the body is forced to release even more insulin. Letting blood sugar get too high is simply not acceptable. The resulting excess of insulin in the bloodstream is called hyperinsulinemia. But the body wasn’t designed for these prolonged high levels of insulin, which disrupt cellular metabolism and spread inflammation. Diabetes occurs when the body is unable to keep blood glucose under control. But as we have noted, that is only the most obvious disease caused by insulin resistance. There are many negative health effects before full-blown diabetes.

Syndrome X and menopause

Of special concern to women is how insulin resistance disrupts fat metabolism. When the cells won’t absorb the extra glucose, the liver has to convert it into fat. Fat cells are loaded with glucose receptors, so this is a vicious cycle. Ironically, while the insulin-resistant woman is gaining weight, her cells are actually “starved” for glucose, so she feels exhausted and tends to eat carbohydrate-heavy foods in search of energy.

These extra fat cells are also little estrogen factories. So weight gain contributes to the estrogen dominance that causes so many symptoms during the early stages of perimenopause.

Symptoms relating to syndrome X usually predate the onset of menopause, but most women do not complain of them until then. A woman’s health can deteriorate rapidly during menopause with the decrease of estrogen levels in the body. And digestive issues that were once merely a hassle become an affliction when the body’s natural defenses against inflammation (estrogen being one) are depleted.

In addition, women approaching menopause are particularly prone to becoming insulin resistant due to metabolic changes related to fluctuations in adrenal and thyroid secretions. In fact, the decrease of certain hormones, like estradiol, may trigger a resistance to insulin in patients who never experienced it before. Certain blood pressure medications can mask symptoms without treating the problem. Frequently, women unwittingly make their symptoms worse by trying to lose weight with low-fat, high-carbohydrate diets.

How do I know if I’m insulin resistant?

The unfortunate truth is that anyone can become insulin resistant — even if she is thin because we have access to a lot of refined carbohydrates (white bread, sugar, bagels, pasta, potatoes, sodas, processed foods with added fructose, etc.)  In fact, most of us are likely to be somewhat resistant to insulin – it is just a matter of degree. The more processed and refined food that we eat, the more insulin we require to metabolize it. The more insulin in our blood, the less responsive our cells become. As we age, this continual exposure wears out our tolerance for refined carbohydrates and reduces our sensitivity to insulin.

If you suffer from high cholesterol, high triglycerides, or hypertension, you should get checked for insulin resistance, regardless of your weight or age. If you have high blood pressure, it is likely that you are also suffering from insulin resistance, and high blood pressure medication will not cure insulin resistance.

 

By Marcelle Pick, OB-GYN NP

How many times have you reached for a cookie or a bag of potato chips after a bad day? We’ve all been there, and I’m the first to admit that these foods feel good in the short-term. But preventing diabetes means focusing on long-term solutions — nutrition, exercise, balance!

In fact, a recent study done on over 3000 people at risk for diabetes showed that lifestyle interventions, such as weight loss and regular exercise, reduced the incidence of type 2 diabetes by 58%, whereas Metformin, a common antidiabetic drug, reduced it by only 31%. Additionally, whole foods rich in phytonutrients — such as those emphasized in the Mediterranean diet — have been shown to be favorable in lowering markers of insulin resistance. What all this research tells us is something that makes complete sense — that preventing diabetes through a holistic lifestyle approach is far easier and more effective in the long-term than any drug solution could ever be. And the first cornerstone of diabetes control is diet.

Nutrition — our food talks to our genes. If I had to pick the gold star in preventing diabetes, it would be food. What you eat can prevent and even control type 2 diabetes. At Women to Women we view food as complex information that our cells have been primed through the ages to receive. In other words, good food talks to your genes to keep things going just the way Mother Nature intended. Rising rates of type 2 diabetes should come as no surprise when you consider that the ways in which we grow and process our food have changed so drastically in just one or two generations, while our human genetic constitution hasn’t changed much in 40,000 years!

This might seem like a novel idea, but there is nothing revolutionary about the concept of balanced meals. This means that each time you sit down to eat, you should include protein, complex carbohydrates, healthy fats, and as many non-starchy fruits and vegetables as you can. This will help to keep your insulin levels in balance and make it less likely for you to store too much energy in the form of fat. And with insulin in good control, you will have better balance throughout your endocrine system, including other hormones like cortisol, estrogen and progesterone.

Insulin control is strongly affected by the glycemic index of the foods you eat. The glycemic index of a food is a measure for how quickly insulin rises in response to the amount of glucose entering your blood stream after you eat it. Foods high in protein tend to have a lower glycemic index than carbohydrates. Simple carbs, like white flour and sugar, have a higher glycemic index than complex carbs like whole grains and fresh fruits. Simple carbs can overload your insulin receptors and make insulin resistance more likely to develop. To prevent the quick sugar surge from high glycemic foods, balance each snack and meal with all four basic groups.

But it’s about more than just the ratio of protein to carbohydrate to fat in your diet. The plant kingdom has been quietly evolving alongside us humans for many years, and the micronutrients available in fresh, richly colored, organically grown fruits and vegetables are instrumental in preventing the diseases of modern life — including type 2 diabetes. So choose the best information your food dollar can buy, and remember that all four food groups play key roles in your digestion, metabolism and hormonal balance.

Exercise — move your body. Getting regular exercise is another excellent way to help prevent yourself from developing type 2 diabetes. Not only does it keep your weight down, but it lowers blood sugar, helps you utilize insulin more efficiently, keeps your cholesterol levels balanced, and improves circulation, thereby keeping your heart and blood vessels healthy and strong. Exercise also supports nervous system health and releases positive endorphins to boost your mood! The benefits are endless.

While cardiovascular exercise is specifically beneficial to your heart, toning muscle — through weight training, yoga, Pilates or swimming, for example — is also a great way to increase the activity of your insulin receptors and prevent insulin resistance. This is because of all the tissues in your body, your muscles use the most glucose, so they are most important for keeping your blood glucose levels steady. And once you learn how good it feels to move your body, you’ll be looking forward to fitting exercise into your schedule as much as possible!

Blood glucose — better regulation through diet and lifestyle. Of course blood glucose is important as well — it’s what we’ve been talking about getting into balance. For women who already have diabetes, it’s important to check blood glucose daily. But for those concerned with preventing diabetes, I recommend getting it checked a couple times a year to see if it’s trending upward.

As I mentioned above, a normal fasting blood glucose should be well under 100 mg/dL, but it is much more important to watch the trend. Once you go above 100 mg/dL, you are considered prediabetic, which usually means that your blood glucose levels are somewhere between 100 and 126 mg/dL — higher than normal, but not high enough to be considered diabetic. You are insulin resistant at this point and much more likely to develop type 2 diabetes and other factors associated with metabolic syndrome — unless you step in.

Rather than focus on the numbers, know that you have much more control over blood glucose by eating well and getting more exercise. Astoundingly, 65% of diabetes patients die from heart disease or stroke, which tells us that treatment should be about more than just glucose control. Making lifestyle changes allows you to reap huge benefits in blood sugar control right away.

Emotions — feed your soul! You can’t go wrong with good diet and plenty of exercise, but at Women to Women, we understand that there’s more to this equation than just eating right and exercising. And that’s the emotional piece. Reaching for sugar may be a sign that you’re lacking sweetness in your life. I want you to think about all the things that make you happy and consider the possibility that these things nourish you in profound ways that your food — no matter how impeccable — cannot. Whether it’s spending more time with your children, relaxing on your own, painting or digging around in the garden, giving yourself time to do the things you love will have a positive effect upon all your systems — from your heart to nerves to immunity to metabolism.

Just remember that feeling better means looking at the whole picture — your happiness, nutrition, exercise habits, hormonal balance, blood pressure, and cholesterol. But while we always encourage women to start inward on a quest for overall health and diabetes prevention, it also makes sense to look at what’s all around you.

Diabetes and our environment

From the four pillars outlined above, we can begin to see how the rising rates of diabetes may be the result of a complex interplay between our genes and environmental influences. It stands to reason, then, that scientists are starting to look more closely at how our environment affects our risk of diabetes. No one will argue with the fact that as modern technology surges on, we benefit from lots of conveniences. But along with all these conveniences we’re also taking in the heavy metals and man made toxins that come with them. Materials used to create plastics, pesticides, household cleaners, flame retardants, rugs and furniture, computers — even white paper — all contain what are known as endocrine disruptors. And many of these foreign molecules have been shown to mimic the action of hormones in our bodies.

Since hormones turn on and off bodily functions, open cell doors, keep our moods stable, and so much more, it makes sense that endocrine disruptors could contribute to a shift in insulin production or utilization in the body. In fact, a recent study found that exposure to the specific kind of endocrine disruptors known as persistent organochloride pollutants (POP’s) may contribute to the development of type 2 diabetes.

Keep in mind, however, that endocrine disruptors are most likely not the primary cause of type 2 diabetes, though they certainly may contribute. And the good news is that there are many things you can do in your life to limit your exposure to these unwanted disrupters. Start by throwing out your plastic food containers and replacing them with glass, avoiding the use of plastic in the microwave, and giving your body a chance to recover by implementing regular detox and drinking more water.

There are lots of ways to help yourself when it comes to the prevention of type 2 diabetes. Just remember to look at the whole picture.

The Women to Women approach to reducing your risk of diabetes

At Women to Women, we believe you are the most important caretaker of your body. This leaves you with choices when it comes to what you eat, whether you exercise, and the spaces with which you surround yourself. This can be a powerful — and, for some women, overwhelming — concept.

But making better choices doesn’t have to be difficult. Start by determining where you are and what your goals are. You may want to put it all down on paper. We find that articulating and defining what we want and don’t want in life can help us more easily achieve our greatest desires.

Here are a few ideas to get you started:

• Move toward healthier meals and snacks. It may be true that fast food is less expensive and more expedient than buying fresh whole foods and cooking yourself, but keep in mind the old adage: Food is the cheapest medicine you can buy. And when you do need to eat in a hurry, even making different fast food choices can make a world of difference. Chose the grilled chicken instead of a cheeseburger next time. Or simply drink water instead of soda with your meals. Be sure to include the four food groups in all your meals, and don’t forget to check the labels for trans fats and high-fructose corn syrup. Remember that you don’t have to do everything all at once. Little by little, making better food choices will help you reverse your insulin resistance within weeks. You may find our articles on nutrition helpful as you prepare to balance your meals.
• Strive for regular physical activity. We don’t advise jumping right into the recommended 40 minutes a day if you haven’t exercised in a while. Just start by doing something active a few days a week. Getting into the habit of moving your body and increasing your heart rate is what counts. Be sure to talk with your healthcare practitioner about what forms of exercise are safe for you. Proceed from there to find an activity that fits your life. Nearly everyone can benefit from walking more. Before you know it, you’ll work up to a longer period of exercise and start to feel all the positive results!
• Enhance your nutrition with vitamins and minerals. Our cells are constantly using micronutrients in their everyday functions to produce energy and keep us thriving. Diabetes and prediabetes compromise the nutrients our bodies are able to take up, which can lead to nutritional deficiencies. Adding a high-grade multivitamin/mineral complex and supplemental omega–3 fatty acids will help fill in any nutritional gaps, regulate hormones such as insulin, and protect your body from the complications associated with diabetes. In fact, certain vitamins, minerals, and phytonutrients have been shown to be particularly helpful in terms of insulin resistance and diabetes.
• Detox your personal environment. Avoid unnecessary chemical exposure by using glass instead of plastic to store your food and drink. Never use plastic in the microwave, or avoid the microwave altogether. Make a point to use all-natural cleaning products and cosmetics, and drink plenty of water.

It will also help your health on all levels, including your endocrine system, to limit time you spend in stressful relationships and environments. As scientists are now discovering, stress takes a heavy toll on our bodies. Ironically, the very technology invented to save us time, such as laptops, cell phones and e-mail, may afford us less time to decompress. Make time to relax and get away from the pressures of life. Even if it’s just a one day yoga retreat, a walk on the beach or an hour-long bubble bath, taking a holiday from stress is never a bad thing for your body.

• Consider other complementary treatments. As you may understand by now, diabetes is a complex disease. It manifests itself differently in each individual and the preventative methods that work for some may not be enough for you. Certain complementary treatments have shown positive effect in managing the risk factors leading to diabetes, and may be worth looking into. Whatever course of treatment you pursue, remember to work closely with an experienced practitioner for the best results.

Find the sweetness in your life!

Learning how to prevent type 2 diabetes changes the way we look at everything — the way we eat, travel, exercise, work, and view the world around us. And, trust me, all of this is for the better! It can certainly feel overwhelming sometimes. It helps to remember that you can’t change everything in one day — nor should you try. Revising our habits takes time and commitment.

At Women to Women we believe in balance, which is achieved through a dynamic equilibrium between forces. There are positives to every negative, and though preventing diabetes may seem daunting, what it requires is for you to pay more attention to your body and do what makes you feel good in the long run. This is never a bad thing. Embrace the chance to take better care of yourself, and before you know it life will be sweeter than you ever imagined possible!

 

by Marcelle Pick, OB/GYN NP

Most women I talk with at the clinic and in my personal life have experienced sugar cravings, no matter what time of year — or time of the month. Whether it’s having a taste for something sweet after dinner each night or speeding to your local supermarket for the biggest bag of Swedish Fish you can buy, I know craving sugar can be a powerful urge. And the disappointing truth is that once we start to include sugar into our daily routine, it becomes more and more difficult to stop.

As humans we’ve evolved to appreciate the instant energy sugar provides us, but food is a highly emotional topic, especially when it comes to sweets. We often associate sweet foods with love and acceptance, and scientists have looked at our brain chemistry to understand how food can directly affect our “feel-good” neurotransmitters like serotonin. There are many other physical causes for sugar cravings, too, like hormonal fluctuations, intestinal yeast, and stress, to name a few.

Pre-tox before you party

Sugary treats are almost always available at parties and special events, as well as other celebratory hazards that can disrupt even the healthiest lifestyle. If you’re planning to celebrate, there are some simple steps to take before you indulge to help pre-tox your system, and keep you feeling energetic and healthy.

Sadly, we’ve been told for far too long that indulging in sweets is connected with a lack of self-will or some other character flaw. This is just not true! Craving sugar is not simply about willpower, nor is it simply about emotions. There may be several underlying physiologic causes feeding your desire for sugar, and it may take some perspective and investigation to get to the bottom of it. Let’s take a closer look at what might be behind your sugar cravings and how you can develop a healthy, loving relationship with sweets.

Why does sugar feel so good?

There is so much contributing to the positive feelings we associate with sugar. For many of us, the smell of homemade cookies or a cake fresh out of the oven reminds us of our childhoods, evoking fond memories of past holidays, birthdays, or special occasions. Others remember being rewarded with candy or other sugary delights when they did something “good.”

These positive associations are deeply ingrained in our brains. I once had a patient named Jillian who broke down into tears when I suggested she cut sugar from her diet for a week — it was as if I was taking away her most intimate friend! But the more research I did, the more it made sense. Our brains “reward” us by releasing serotonin and beta-endorphins when we eat sugar or other refined carbohydrates that are easily converted to glucose (the simplest sugar). The release of these mood-enhancing neurotransmitters explains in part why Jillian and many other patients of mine feel such an intense emotional connection to sugar.

Let’s look at serotonin. Serotonin has many responsibilities in our bodies, but overall, it is best known as the neurotransmitter that makes us feel good. Neurotransmitters act by sending messages from the nervous system to the rest of the body, and serotonin levels are what several antidepressants manipulate to improve mood and anxiety. Made from the essential amino acid tryptophan, serotonin’s roots are in protein. So what does sugar have to do with it? The reason sugar can lead to increased serotonin in the brain has to do with insulin. I’ll explain this in more detail below, but the bottom line is that we need insulin to help tryptophan get into the brain so it can produce serotonin. And sugar — or any carbohydrate for that matter — causes us to release insulin. Refined carbohydrates, such as sugar, white bread, pasta and white rice, lead to a more intense insulin surge than do complex carbohydrates like vegetables and whole grains.

Beta-endorphin is another neurotransmitter we release when eating sweets or refined carbohydrates. This is the neurotransmitter typically associated with a “runner’s high” because it acts as a natural painkiller, produces a sense of well-being, increases self-esteem, and settles anxiety. Our brains naturally release beta-endorphin when we are in any kind of physical pain — and when we eat sugar.

It’s no wonder sugar feels so good! Physiologically, sugar “feeds” our brains with two neurotransmitters that send positive messages to the rest of the body. The problem is that the lift we experience after a can of soda, a bowl of noodles, or a chocolate chip cookie doesn’t last very long, and eating these foods, especially without combining them with some protein, can set us up for cyclical cravings. We will find ourselves wanting more and more.

Is sugar addictive?

So many of my patients ask whether sugar is truly addicting, but the answer differs depending on the individual. Sugar certainly can be addictive, but this is more of a problem for some women than others, because we all have different levels of neurotransmitters and receptors in our brains. These levels vary and change over time depending upon our genetics and lifestyle — what we eat, drink and feel; where we are hormonally; whether we exercise; how well we sleep; and so on. Some practitioners believe that a portion of the population is “sugar-sensitive.” These individuals may be operating with naturally lower levels of serotonin and beta-endorphin, leaving them more vulnerable to sugar cravings.

Any time the body is running low on a neurotransmitter, the brain tries to catch up by opening up more receptors for this neurotransmitter, essentially to increase the odds of a connection. You can think of it in terms of supply and demand: when there’s less of something available, the demand for it goes up. With so many open receptors, if a sugar-sensitive person does have sugar, alcohol, or anything that causes a release of serotonin or beta-endorphin, it intensifies the resulting sugar “high.” This in turn can lead to more cravings.

Some of my patients have experienced withdrawal symptoms when they stop eating sugar. This makes sense because when we’re eating large amounts of sugar at regular intervals, the brain becomes accustomed to frequent beta-endorphin bursts, and when we take them away, it naturally wants more. This, like withdrawal from a caffeine habit or drug addiction, can lead to headaches, shakiness, nausea, fatigue, and even depression.

Your body needs carbohydrates

It may be tempting for women who feel they have a problem with sugar to simply cut out all carbohydrates. But an all-or-nothing approach just isn’t healthy — it takes all four food groups to regulate insulin and quell sugar cravings. Here is an explanation why:

Whenever we eat foods that contain complex carbohydrates, our bodies convert them into a simple sugar known as glucose. Glucose is the main source of fuel for our cells. The brain in particular cannot use any other source of energy (like fat or protein) aside from glucose, so it is absolutely essential to eat carbohydrates.

As I mentioned earlier, carbohydrates are also important in helping tryptophan get into the brain to be converted to serotonin. When we eat food containing protein, the body breaks it down into subcomponent amino acids — one of which is tryptophan.

Key nutrients to enhance your serotonin production

• Vitamin C. Among other important duties, vitamin C helps to convert tryptophan (from the food you eat) into serotonin.
• B-complex vitamins. This group of vitamins is helpful in metabolizing carbohydrates for the body to use. Niacin in particular is essential in converting tryptophan to serotonin.
• Zinc. Zinc aids insulin in doing its job and generally helps with digestion.

— Adapted from Potatoes not Prozac, p. 141

The tryptophan molecule is relatively small compared to other amino acids. Those larger amino acids can block tryptophan’s path across the tightly-regulated barrier between the blood and the brain. When carbohydrates are consumed and insulin is released, insulin pairs up with larger amino acids to help build muscle, leaving tryptophan a clearer path to cross into the brain. And there are important micronutrients, such as vitamin C, the B vitamins, and zinc (see box at right), that can help with the conversion from tryptophan to serotonin.

What’s interesting is that Mother Nature did not provide our bodies with the information to distinguish between man-made sugars and natural sugars. Instead, this information is available to us in everything else that surrounds natural sugars — in the antioxidant-rich skins of grapes and apples, for example, or the fiber and protein-rich germ of whole grains. Therefore, eating any kind of sweet or refined carbohydrate will satisfy the brain and increase serotonin — but it won’t trigger the signals that tell our brain we’ve had enough, that we are now fully sated. The more refined a food is, the more it’s been stripped of this natural, information-rich fibers, fats, proteins, vitamins, and antioxidants.

The carbohydrates in white flours, white rice, white sugar, and the majority of pastas and breakfast cereals are all highly refined, so it takes less time for the body to break them down, therefore leading to a quicker response all around. This may sound good, but in the long run, quick spikes in insulin and glucose can damage your metabolism and lead to insulin resistance and more cravings. There are so many delicious complex carbohydrates to choose from that will gently increase blood sugar and insulin.

Possible causes for sugar cravings

As I mentioned earlier, sugar cravings often have many facets. Because eating is so intimately connected with our biochemistry and our emotions, we “digest” sugar on many levels. You may notice there’s a pattern to when you crave sugar — for so many of my patients it is cyclical, occurring nightly after a stressful day at work, monthly just before their periods, or seasonally when the days grow short. For others, sugar binges may be connected to the kinds of foods they have already eaten that day, or with a daily ritual. Here are some of the common causes for sugar cravings I see at the clinic:

• Hormonal fluctuations. Just before menstruation, when estrogen is low and progesterone is on its way down, beta-endorphin levels are at their lowest. These cyclical hormonal and neurotransmitter fluctuations may explain why many women who experience PMS also have cravings — and the accompanying serotonin–endorphin bursts that high-sugar foods can provide.
• Stress. Any stressful situation can lead to less than optimal eating habits. Stress itself increases cortisol levels, which initially dampen hunger. Once the stress has abated, our hormones of hunger ramp up — “Refuel!” the body cries. This can lead many women with stressful jobs and lifestyles to a pattern of nighttime cravings, over-eating, and unwanted weight gain. Over time, chronic stress can lead to adrenal imbalance, eventually resulting in extreme exhaustion. So many women I see have reached a state of adrenal imbalance, and find the only way to get through the day is by drinking lots of caffeine and consuming sugar for quick energy bursts. But this only sets them up for further cravings and more energy depletion. There are lots of simple ways to support your adrenal health by what and how you eat. For more information, see our articles about eating for your adrenal glands.
• Insulin resistance. When you are resistant to insulin (which can happen as a result of a long-term diet high in refined carbohydrates and low in micronutrients), glucose is not able to enter your cells and ends up staying in your blood as a result. This means your cells are starved for the fuel they need to operate, and signals are therefore sent to your brain to increase insulin. This results in cravings for sugar because even though you may be eating enough, your cells aren’t able to access the food. For more information, see our article on preventing type 2 diabetes and metabolic syndrome.
• Food sensitivities. Food sensitivities are often the result of a situation known as “leaky gut,” where partially digested food particles can make their way into the bloodstream through a damaged, inflamed mucosal lining in the digestive tract. The body regards these food particles as foreign antigens and mounts an immune response by sending antibodies. Combined antibodies and antigens in your bloodstream, known as immune complexes, can lead to intense cravings. Gluten may be at the root of this type of sugar craving because it is often combined with sugar in the foods we eat, and so women think they’re craving sugar when really they might be craving gluten.
• Intestinal yeast or systemic candidiasis. Yeast thrives on sugar (a connection easy to make when you look at the Latin name for this group of organisms — Saccharomycotina — or “sugar fungi”). If your intestinal (and vaginal) bacteria are out of balance, they are less likely to keep yeasts like Candida in check. An overgrowth of yeast in the intestine or system-wide can lead to increased cravings for sugar. You can help keep these organisms — and cravings — in check by taking a high-quality probiotic that includes a competitive yeast.
• Excess acid-forming foods. Some women I talk with notice that after eating a lot of red meat, their cravings for sugar increase. Red meat is high in a pro-inflammatory molecule called arachidonic acid. Eating a lot of meat tends to upregulate the oxidative–inflammatory cascade in our bodies. If left unchecked, this inflammatory condition can become chronic and cause abnormal glucose metabolism, ultimately leading to insulin resistance. Choosing anti-inflammatory foods high in omega-3 fatty acids, as well as those that are alkalizing and antioxidant-rich, such as fruits and vegetables, can offset the metabolic damage and the cravings associated with this dynamic.
• A lack of sweetness in your life. As I mentioned before, many things in life can affect our serotonin and beta-endorphin levels — exercise, balanced nutrition, rewarding work, a positive relationship, even a sunny day. The joy we find in our lives speaks to our biochemistry. So when we are lacking positive energy and happiness, it’s not surprising that we seek to fill that void with sugar.

Strive for a sweet balance — the Women to Women approach

There are several ways to diminish sugar cravings, but just as there are different causes for them, different steps work for different women. For my patient Jillian and others who are addicted to sugar, multiple steps may need to be taken for lasting results. Other women may find that simply avoiding sugar for a few days does the trick. Still others find that once they reach menopause and their hormonal swings become a thing of the past, so do their cravings. But the best approach is to find a good balance. I’ve seen too many women put sugar in the “forbidden fruit” category and end up binging because they feel so deprived. You deserve treats in your life, and sugar can be enjoyed without the “carb hangovers” and guilt that are too often associated with it.

Here are some suggestions to help you find a healthy middle ground between no sugar and sugar binges.

Balance your diet. Nourish your body with a balanced diet, full of the healthy fats, quality protein, complex carbohydrates, and fruits and vegetables that all together help keep cell-signaling on an even keel. The food you prepare for yourself should be yummy and rewarding, not something you have to force down. So many fad diets are set up to deprive women of basic food groups, like fat and carbohydrates, but our bodies need all of these food groups to carry out basic functions. Treat yourself to satisfying foods, and I promise you’ll see a difference in your cravings. For more on preventing insulin resistance with nutrition, see our articles on this topic.

Try eliminating sugar for three to five days and see how you feel. I know how hard it can be, but avoiding sugar for just three days can make a huge difference for some women. For others, it may take longer for the cravings to diminish, but eliminating the cyclical crash-and-burn bursts of serotonin and beta-endorphin your brain gets from sugar and refined carbohydrates can help your body normalize its receptors and neurotransmitters, so that your brain isn’t constantly sending the message that it needs more sugar.

Incorporate a high-quality multivitamin–mineral complex, plus omega-3s. A good supplement is essential to cover your nutritional bases, especially in our modern society of fast food and industrial farming. Micronutrients like zinc, vitamin C and the B vitamins are particularly helpful in calming sugar cravings by influencing serotonin production. Equally important are omega-3s, which are crucial for regulating mood and inflammation — factors that are both associated with cravings.

Eat a baked potato three hours after dinner. This concept was born when Dr. Kathleen DesMaisons published her famous book, Potatoes not Prozac. We recommend you read the book for specifics, but the theory is that potatoes not only stimulate the release of insulin needed for tryptophan to cross into the brain, but also contain potassium, a nutrient needed for insulin to do its work. Potatoes, with their fiber and micronutrient content, also offer a more sustained insulin response than most refined carbohydrates. The only stipulations are that you eat the potato as an evening snack, that you do not eat it with any kind of protein (otherwise, you can top it as you wish), and that you include its skin. You may notice that this runs counter to our advice to combine protein and carbs in meals and snacks — keep in mind that eating a baked potato in this specific way, three hours after a meal containing protein, is one particular method of reducing cravings and preventing mood swings. The following is our more general recommendation about controlling insulin surges.

Mix protein with pleasure. We can all indulge ourselves in sugary treats once in a while if we want to. Combining these treats with a stick of cheese, some nuts, or even a glass of milk will help balance the sugar and insulin surge and allow a gentler increase in blood sugar and insulin. We also recommend desserts that include protein, like custards or meringues or even a bowl of berries and cream. You can sweeten these delights with natural sweeteners like stevia or xylitol instead of sugar. With a less spiky sugar surge to the brain, you’ll likely experience a less precipitous crash as well. See our articles about carbohydrates for an alternative explanation about the concepts of glycemic index and glycemic load.

Avoid sugar patterns. Just like those who smoke or drink may associate smoking or having a glass of wine with certain activities, we may come to associate sugary treats with times of the day or ritualized rewards. Take a moment to notice whether this might be true of your cravings. Your brain is quick to pick up on associations — particularly anything having to do with its “reward cascade” — and may have you craving sugar every day at three o’clock, or each time you go for a run, for example. If you’re ready to break the pattern (or prevent it from forming), this might be a good time to enjoy that baked potato or some alternative “reward.”

Enhance the sweetness in your life. One of my favorite prescriptions for my patients reads: Go have some fun! I have written this prescription several times for patients who seem buried in their work or the day-to-day responsibilities of raising a family, taking care of elderly parents, managing a household — whatever it may be. As women, we rarely take the time to nurture ourselves, and it is so important to your health to do so on a regular basis. Take a step back to figure out what makes you happy, and examine the things that are doing the opposite. It may be time make a change.

Cultivate lasting bliss

I know it doesn’t feel good to be a slave to sugar. The ups and downs can be intense and exhausting overall. But it doesn’t have to be this way. Look at the whole picture — biochemically, physically, and emotionally — to pinpoint where you might benefit from change and release yourself from your cravings. The more balance you can offer yourself through quality nutrition and emotional wellness, the more you’ll find your cravings start to shift away from quick fixes like sugar to the things that provide a lasting and natural bliss.

I absolutely know that craving sugar or binging on sugar is not a reflection of your willpower or your individual strength. It most likely has physical roots, and those roots can be restored to set the foundation for a healthy, lifelong relationship with sugar!